Hello, friend. Thank you for taking a moment to fill out our health intake. Your safety is our utmost priority, so please complete the information as clearly as possible. Anything you share with us is 100% confidential.
How did you hear about us?
Have you ever experienced psychedelics before?
Do any of the following medical conditions apply to you?
Have you ever been hospitalized for any of the above?
Have you ever had any issues with your blood pressure?
Have you ever been diagnosed, treated, or self-identified with a substance use dis-harmony (disorder)?*
Have you experienced or been diagnosed with any of the following? Click all that apply.
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